European alternative to Botox hits U.S.

BEAUTY

Dr. Corey Maas conducted clinical trials of the new wrinkle-reducer, Dysport, which is a competitor to the very popular "Botox, " as he sits in his examining room in San Francisco on June 26, 2009.

Dr. Corey Maas conducted clinical trials of the new wrinkle-reducer, Dysport, which is a competitor to the very popular "Botox, " as he sits in his examining room in San Francisco on June 26, 2009.

Photo: Frederic Larson, The Chronicle

Photo: Frederic Larson, The Chronicle

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Dr. Corey Maas conducted clinical trials of the new wrinkle-reducer, Dysport, which is a competitor to the very popular "Botox, " as he sits in his examining room in San Francisco on June 26, 2009.

Dr. Corey Maas conducted clinical trials of the new wrinkle-reducer, Dysport, which is a competitor to the very popular "Botox, " as he sits in his examining room in San Francisco on June 26, 2009.

Photo: Frederic Larson, The Chronicle

European alternative to Botox hits U.S.

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Consider it a milestone in the war against wrinkles: Dysport, the first alternative to Botox, is now available in the United States.

Dysport has been used in Europe for years, but Bay Area residents officially got their first taste of it during the past two weeks, when it became widely available to doctors after being approved by the U.S. Food and Drug Administration.

Approval came after five years of clinical trials across the nation, including the offices of plastic facial surgeons Dr. Corey Maas of San Francisco and Dr. Mary Lynn Moran of Woodside.

"With Botox, I found that it didn't work right away - it took longer than Dysport," said Sarah Lewis, 58, a bank executive and patient of Moran's, who used the substance on frown lines and to prevent migraines. "With Botox I'd have to go in for touchups. It wore off pretty quickly and economically was a drain."

Like Botox, Dysport contains the muscle-paralyzing botulinum toxin A. But there are some minor differences, according to doctors who participated in the clinical trials. It appears to take effect a day or more sooner than Botox, which works in about four days; appears to last a month or more longer than Botox, which typically wears off in three months; and it might spread slightly into other areas of the face.

It is also cheaper for doctors, who pay about $525 per vial of Botox (a powder reconstituted with saline solution) and about $475 for a similar dose of Dysport, and perhaps cheaper for patients, if doctors pass the savings along.

Botox is made by Allergan Inc. Dysport is marketed in the United States by Medicis, which also makes Restylane and Perlane, fillers that plump creases and create pouty lips.

Maas, the dean of Bay Area Botox dispensers, was the first doctor to use Botox for cosmetic applications in San Francisco 17 years ago.

A former UCSF faculty member, he conducted early studies of a Botox precursor called Myobloc, and was selected by Medicis to work with a team of experts to design clinical trials for Dysport beginning in 2003.

Some 5,000 patients at 30 centers across the nation participated in the study, in which only the glabellar lines, or vertical frown lines between the eyebrows, were injected.

San Francisco dermatologist Dr. Seth Matarasso, one of the nation's leading individual dispensers of Botox by volume - 10 vials, or enough for 40 patients, on a slow day - is conducting his own study of Botox and Dysport, independent of any drug company. This summer, he is injecting 30 patients in the crow's feet area, one side with Botox and one side with Dysport, hoping for preliminary findings on whether they act similarly side by side and how long they last, among other things.

"It's almost going to be a Diet Coke versus a Diet Pepsi thing," Matarasso said.

Said Maas: "People will be at least as happy with Dysport as with Botox - it's not substantively different."

Still, every doctor interviewed for this story emphasized the importance of having a medical specialist inject the drug, for safety's sake.

The drugs are measured by potency, with the weight of the substance measured in nanograms, or one-thousandth of a milligram, and 3 or 4 nanograms to a bottle, Maas said. Doctors across the nation are calling one another to confer about dosage.

"One unit of Botox is different from one unit of Dysport," Maas said. "The people injecting at the shopping mall are probably not the best people to administer this drug."

Moran said competition could keep prices in check, and get new patients in for checkups, too.

"It gives me an opportunity to talk to people about sun exposure, genetics and skin cancer," she said.

Rosie Mendoza, 52, an insurance agent from Redwood City who had never used Botox and participated in Moran's clinical trial, wants to keep up her Dysport treatments, to her own surprise.

"I don't feel like a grandma," she said. "I feel like my outside matches my inside. I will go back to the doctor every four or five months."